EPPP- Ethics

Avoid biased language re: disability

(a) Avoid negative and condescending language. Use "person in a wheelchair" rather than "person confined to a wheelchair" and "person with AIDS" rather than "AIDS victim." (b) Use person-first language or, when preferred by the community or individual, identity-first language. "Adolescent with autism spectrum disorder" and "people with visual impairments" are examples of person-first language, and "autistic adolescent" and "visually impaired person" are examples of identity-first language. (See, e.g., Choosing words for talking about disability, 2015.)

Avoiding Biased Language re: sexual orientation

(a) Avoid pejorative and inaccurate terms (e.g., homosexual, homosexuality). Instead, use specific, identity-first terms to describe sexual orientation (e.g., lesbian women, bisexual people). (b) Use the term "sexual and gender minorities" to refer to multiple sexual and/or gender minority groups. Abbreviations such as LGBTQ and LGBTQ+ are acceptable as long as they are defined and are representative of the group being described.

Primary Goals of Ethics Codes

"the welfare and protection of the individuals and groups with whom psychologists work and the education of members, students, and the public regarding ethical standards of the discipline."

Standard 6: Record Keeping and Fees

(Record Keeping and Fees) of the Ethics Code provides ethical requirements for professional records and financial arrangements.

Avoid biased language re: race (general guidelines)

(a) Capitalize racial and ethnic groups (e.g., Blacks, Whites, African Americans). (b) Don't hyphenate names of racial and ethnic groups when used with a third term (e.g., Asian American participants). (c) Avoid using the terms "minority" or "minorities" without a modifier. Instead of "minorities" and "minority students," use "ethnic minorities" and "racial-ethnic minority students." (d) Make parallel comparisons among groups. Instead of "African Americans and Whites, use "African Americans and European Americans" or "Blacks and Whites."

Avoiding Biased Language re: Gender

(a) Don't confuse gender and sex: Gender refers to social identity (e.g., cisgender, transgender, gender non-conforming), while sex refers to biological sex assignment. (b) When writing about a specific person, use that person's self-identified pronouns whenever possible. When writing about a person whose self-identified pronouns are unknown or a person who is hypothetical or generic and gender is irrelevant to the context, use "they," "them" and "their" as singular pronouns - e.g., "One of the students left their backpack in my office."

informed consent for court ordered services (part of standard 3)

(b) Court-Ordered Services: Standard 3.10(c) states that, when psychological services are court-ordered or otherwise mandated, psychologists must inform the person about the nature of the services, that the services are court-ordered or mandated, and about any limits of confidentiality. Court-ordered evaluations are also addressed in Paragraph 6.03.02 of the APA's (2013) Specialty Guidelines for Forensic Psychology which states that, when an evaluation is court-ordered, forensic psychologists must describe the nature and purpose of the examination but can conduct it without the examinee's consent. It also states that, if the examinee refuses to be evaluated, a psychologist "may consider a variety of options including postponing the examination, advising the examinee to contact his or her attorney, and notifying the retaining party about the examinee's unwillingness to proceed." Standard 3.10(d) requires psychologists to "appropriately document written or oral consent, permission, and assent." Note that the circumstances may determine the required or appropriate type of informed consent. For example, laws or institutional regulations may require a signed written informed consent. And, in some situations, oral consent with documentation is preferable - for example, when providing services to members of certain cultures who object to written consents, when the individual has low literacy skills, or when it's important to preserve the anonymity of research subjects.

Discussing confidentiality with group therapy members (part of standard 4)

(b) Group Therapy Members: Standard 10.03 requires psychologists who provide group therapy to describe "the roles and responsibilities of all parties and the limits of confidentiality." Psychologists cannot guarantee the confidentiality of information revealed in group therapy because group members are not ethically bound to maintain confidentiality by professional codes or subject to legal liability if they breach confidentiality (Fisher, 2017). However, psychologists can reduce the likelihood that confidential information will be disclosed by educating group members about the importance of maintaining confidentiality and the possible negative consequences of not doing so and by discussing confidentiality during the screening interview, the initial group therapy session, subsequent sessions as needed, and the final session (Knapp & VandeCreek, 2006).

Assessment techniques and modifications (part of standard 9)

(b) Standard 9.02(a) requires psychologists to use assessment techniques "in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques." This includes using tests for purposes that are supported by empirical evidence and administering and scoring tests using standardized procedures. Standard 9.02(b) states that psychologists use tests "whose validity and reliability have been established for use with members of the population tested." However, it also states that, "when such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretations." Fisher (2017) points out that testing procedures may require adaptation when a test is administered to examinees with disabilities, and she states that Standard 9.02(a) permits deviating from standardized procedures when doing so is supported by research or other evidence. Adaptation of testing procedures is also addressed in the Standards for Educational and Psychological Testing (AERA, APA, & NCME, 2014). It describes adaptations as changes made to a test to increase its access for certain test takers that can take the form of accommodations or modifications: Accommodations are "relatively minor changes to the presentation and/or format of the test, test administration, or response procedures that maintain the original construct and result in scores comparable to those on the original test" (pp. 58-59). Using a large-print or braille version of a test of content knowledge for visually impaired examinees is an example of an accommodation. Modifications are changes to test content and/or testing conditions that alter the construct to some extent and result in scores that do not have the same meaning as scores on the original test. As an example, when a reading test that evaluates reading comprehension and ability to decode written language is modified by providing a screen reader for examinees with dyslexia, the construct measured by the test is altered for those examinees. Accommodations and modifications should be documented in test reports along with a description of how they affect the validity of the interpretation of test scores. In addition, the Standards for Educational and Psychological Testing recommends that modified tests be treated "like a newly developed assessment that needs to adhere to the test standards for validity, reliability/precision, fairness, and so forth" (AERA, APA, & NCME, 2014, p. 67).

Discussing confidentiality with minors (part of standard 4)

(c) Minors: The right to confidentiality does not extend to clients who are minors except in legally defined situations - e.g., when the minor is emancipated or legally able to consent to his/her own treatment. When a minor's parent or legal guardian has the right to information disclosed by the minor, a good strategy is to discuss confidentiality with all parties and establish a confidentiality agreement at the beginning of therapy about what types of information will and will not be shared. For example, a psychologist would want to let the parties know that he/she will contact the parents or legal guardian of the minor client when the client is engaging in potentially harmful behavior and the psychologist believes that doing so will help ensure the client's safety. As noted by Behnke and Warner, in this situation, "regardless of whether an adolescent assents to have information disclosed to a parent, it makes both clinical and ethical sense to tell the adolescent - beforehand, if possible - what information will be shared" and, when appropriate, to include the adolescent in conversations with the parent (2002, p. 4). Finally, psychologists should also inform minor clients and their parents or legal guardians about the circumstances in which psychologists are legally permitted or required to disclose information revealed by a minor client to medical personnel, members of law enforcement, and others - e.g., when the minor poses a severe risk of harm to him/herself or others and when the minor has been physically or sexually abused.

Discussing confidentiality about deceased clients (part of standard 4)

(d) Deceased Clients: The Ethics Code does not explicitly address the confidentiality of deceased clients, but most states have laws that allow disclosure of confidential information pertaining to a deceased client only with the authorization from the client's executor, estate administrator, or other legal representative (Feldman, Moritz, & Benjamin, 2005).

Discussing confidentiality with members of the military (part of standard 4)

(e) Members of the Military: Client confidentiality is not handled in exactly the same way in the military as it is elsewhere, and psychologists providing mental health services in military settings must adhere to Department of Defense rules that limit the confidentiality of mental health information. Johnson (2013) suggests that psychologists working in the military minimize the risk for ethical dilemmas by providing "detailed and exhaustive informed consent regarding the fact that confidentiality can never be guaranteed in the military ... [and by maintaining] conservative documentation of the client's history or private concerns" (p. 109).

Discussing confidentiality in correctional facilities (part of standard 4)

(f) Correctional Facilities: Haag (2006) notes that psychologists working in correctional facilities often face ethical dilemmas related to confidentiality. According to Haag, "in correctional practice, confidentiality can range from essentially no confidentiality (i.e., court-ordered assessments) to levels of confidentiality present in general psychological practice ... with the actual level of confidentiality [typically being] somewhere between these two extremes" (p. 97). He states that, for this reason, it's important to describe the limits to confidentiality to all involved parties at the beginning of professional services. Pinta (2009) proposes that decisions about breaches of confidentiality made by psychologists providing therapy to prison inmates can be categorized as treatment- or security-driven: When making treatment-driven decisions, the therapeutic relationship ordinarily has priority and "principles of confidentiality and beneficence (i.e., acting in the best interests and welfare of patients) are given strict adherence" (p. 151). In contrast, when making security-driven decisions, "the confidential nature of the treatment relationship is respected, but the safety of staff and inmates is given greater importance when there are conflicting values" (p. 152). For example, with regard to the duty to protect (see the description of Tarasoff below), Pinta (2010) notes that, when an incarcerated client reveals to a psychologist that he/she is planning to harm the correctional staff or another inmate and the psychologist believes the threat is serious, the psychologist would meet the duty to protect by breaching confidentiality and reporting the threat to the warden or other appropriate prison official. However, when an inmate reveals that he/she is planning to harm someone outside the prison, the duty to protect may not apply because the inmate does not have the ability to carry out his or her threat. In this situation, the inmate should receive treatment aimed at reducing the risk of violence if the threat is related to a serious mental disorder. Or, if there's reason to believe that the intended victim is at risk (e.g., because the inmate is scheduled to be released from prison in the near future or the intended victim is on the inmate's visitor list), it may be necessary to breach confidentiality by notifying the intended victim or prison officials.

Discussing confidentiality in employee assistance programs (part of standard 4)

(g) Employee Assistance Programs: Employee assistance programs (EAPs) "are designed to help employees address both work-related problems and personal problems outside of work that may be having an adverse effect on job performance" (Chernoff, 2020, p. 254). Client confidentiality is handled in EAPs in the same way it is handled in other therapy situations: This means that confidential information is not shared with an employee's supervisor or employer without the employee's signed written authorization, regardless of whether the employee's participation in the EAP is the result of a self-referral or an informal or mandatory supervisor/employer referral (Government of Canada, 2008; Pitts, 2007). However, as in other circumstances, confidentiality may be breached without the employee's authorization when doing so is legally required or permitted - e.g., to notify appropriate authorities when the employee is a danger to self or others or to report child abuse.

Discussing confidentiality in telepsychology (part of standard 4)

(h) Telepsychology: The provision of professional services via telepsychology increases confidentiality and privacy risks. This is addressed in Guideline 4 of the APA's Guidelines for the Practice of Telepsychology. It states that "psychologists who provide telepsychology services make reasonable efforts to protect and maintain the confidentiality of the data and information relating to their clients/patients and inform them of the potentially increased risks of loss of confidentiality inherent in the use of the telecommunication technologies, if any" (2013, p. 796). Methods for maintaining confidentiality include having password protection on all devices that will be used to exchange emails and texts, ensuring that all confidential information transmitted by email is encrypted, and using videoconferencing platforms that provide adequate security and privacy. In the United States, videoconferencing platforms must comply with HIPAA and state security requirements. HIPAA-compliant platforms utilize appropriate encryption; have secure transmission, audit trails, and breach notification procedures; and will enter into a business associate agreement (Larson, 2019). HIPAA-compliant platforms include Doxy.me, thera-LINK, Zoom for Healthcare, Webex for Healthcare, GoToMeeting, and Skype for Business (but not Consumer Skype).

5 Ethics Standards (names only)

- Principle A (Beneficence and Nonmaleficence) - Principle B (Fidelity and Responsibility) - Principle C (Integrity) - Principle D (Justice) - Principle E (Respect for People's Rights and Dignity)

When APA Can Take Action Against Psychologist

-complaints of unethical conduct - after a member's "conviction of a felony, expulsion or suspension from an affiliated state psychological association, or suspension or loss of licensure." As noted by Fisher (2017), the felony conviction does not have to be related to activities the member performed in his or her role as a psychologist.

Boundaries of Competence (Part of Standard 2)

1. Boundaries of Competence: Standard 2.01 requires psychologists to "provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience." Standard 2.01 also addresses competence in specific situations: For example, Standard 2.01(b) applies to situations in which scientific or professional knowledge has established that an understanding of issues related to gender, gender identity, race, ethnicity, or other characteristic is essential for ensuring that professional services are effective. It states that, to provide services to individuals with these characteristics, psychologists must have the necessary knowledge and training; and, if they do not, they should make appropriate referrals. Standards 2.01(c), 2.01(d), and 2.02 apply when psychologists want or are asked to provide services that are outside their current boundaries of competence: Standard 2.01(c) states that, when psychologists want to provide services to new populations or use new techniques, they "undertake relevant education, training, supervised experience, consultation, or study." This situation is addressed by Koocher and Keith-Spiegel (2008), who note that determining whether it's better to refer or treat a client whose needs are outside a psychologist's level of competence depends on the circumstances: When there's a substantial difference between the client's needs and the psychologist's competence and an alternative provider is available, referral is ordinarily the best choice. But, in other circumstances, seeing the client while obtaining consultation and/or additional training and education may be an acceptable course of action. Standard 2.01(d) applies when psychologists are asked to provide services when they do not have adequate competence and alternative services are not available. It states that psychologists may provide the services when they have closely related training and experience and make a "reasonable effort" to obtain appropriate knowledge, training, and/or consultation. Standard 2.02 allows psychologists to provide professional services in emergency situations, even if they do not have adequate training, when alternative services are unavailable and they discontinue the services as soon as the emergency has ended or appropriate services become available. Standard 2.01(e) addresses the use of new techniques for which there is no consensus about what constitutes competence. It states that, "in those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm." Telepsychology is an emerging area, and competence in the delivery of telepsychology services is addressed in Guideline 1 of the APA's Guidelines for the Practice of Telepsychology. It states that "psychologists who provide telepsychology services strive to take reasonable steps to ensure their competence with both the technologies used and the potential impact of the technologies on clients/patients, supervisees, or other professionals" (2013, p. 793). This includes obtaining the education and training needed to develop and maintain adequate competence in the delivery of telepsychology services and being familiar with research evaluating the effectiveness of telepsychology for different disorders and for clients with different cultural, socioeconomic, and other characteristics. Because of the relative newness of telepsychology, training standards are still being developed and will continue to evolve as technology changes. Consequently, whenever psychologists are uncertain about their competence to provide telepsychology services, the best course of action is to consult with a colleague who has expertise in providing those services. With regard to research, Guideline 1 notes that a lack of empirical evidence for providing therapy via telephone or other telecommunication format "in and of itself, may not be grounds to deny providing the service to a client/patient" (p. 794). However, in this situation, the client should be informed about the lack of empirical evidence and his/her treatment options. Finally, Standard 2.04 requires psychologists to base their work on "established scientific and professional knowledge of the discipline." This includes using evidence-based methods of assessment and treatment when they're available and applicable to a particular client and situation. As defined by the APA Presidential Task Force on Evidence-Based Practice, "evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" (2006, p. 273).

Discrimination (part of standard 3)

1. Discrimination: Discrimination based on age, gender, gender identity, race, ethnicity, socioeconomic status, or other basis proscribed by law is prohibited by Standard 3.01. Note that this prohibition does not mean that psychologists must accept as clients everyone who requests their services. Instead, psychologists may decide to refer individuals seeking services to other mental health professionals when they believe that an individual's values, diagnosis, or other characteristic would negatively affect their ability to provide competent services. Knapp and VandeCreek (1993) note, for example, that it's acceptable for psychologists to refuse to see clients whom they perceive to be unwilling or unable to pay their fees.

Requests from Ethics Committees (part of Standard 1)

3. Requests from Ethics Committees: Standard 1.06 requires psychologists to cooperate with investigations and proceedings of the APA and affiliated psychological associations to which they belong, and it states that failing to do so constitutes an ethical violation. However, like Standards 1.04 and 1.05, Standard 1.06 requires psychologists to consider issues related to confidentiality. For instance, if you're asked by an ethics committee to provide it with information about a current client who has filed a complaint against her previous therapist, you'd want to make sure the client has signed an authorization for release of information before doing so.

Resolving Ethical and Legal/Organizational Conflicts (part of Standard 1)

1. Resolving Ethical and Legal/Organizational Conflicts: Conflicts between ethical requirements and laws, regulations, and organizational demands are addressed in the Introduction and Standards 1.02 and 1.03 of the APA Ethics Code. For example, Standard 1.02 states that, when conflicts occur, "psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code." It also states that, "under no circumstances may this standard be used to justify or defend violating human rights." This provision requires psychologists to make a reasonable effort to resolve a conflict in a way that's consistent with ethical responsibilities but does not require them to abide by ethical responsibilities in all situations. As noted by Fisher, "when reasonable actions taken by psychologists do not resolve the conflict, they are permitted to make a conscientious decision to comply with the legal or regulatory authority under circumstances in which their actions cannot be used to justify or defend violating human rights" (2017, p. 59).

Delegating Work to Others (Part of Standard 2)

2. Delegating Work to Others: Standard 2.05 states that a psychologist must delegate responsibilities to employees, supervisees, research assistants, interpreters, and others only when (a) the person the work is being delegated to does not have a multiple relationship with the recipient of the services that could impede his or her objectivity and effectiveness; (b) the person has adequate competence to provide the services independently or while being supervised as determined by his/her education, training, and experience; and (c) the psychologist ensures that the person provides the services competently. For example, it would be unethical for a therapist to recruit a therapy client's family member to act as an interpreter when the client does not speak the same language as the therapist because the family member's relationship with the client is likely to affect his/her objectivity. With regard to the use of an interpreter, Novotney (2020) notes that not all jurisdictions require interpreters to be licensed or certified, and she recommends that, whenever possible, psychologists use the services of professional interpreters who are certified by a national organization (e.g., the National Board of Certification for Medical Interpreters) and adhere to the National Code of Ethics and Standards of Practice of the National Council on Interpreting in Health Care. She also states that it's important to obtain a client's consent before bringing in an interpreter to assist with therapy or assessment and to discuss with the interpreter the need to maintain client confidentiality. Tribe and Thompson (2017) recommend that psychologists have written guidelines and a contract for interpreters that address confidentiality and other relevant issues, and Novotney states that psychologists who are subject to HIPAA must have a business associate agreement with the interpreter that specifies the interpreter's responsibilities with regard to confidentiality. When delegating work to an employee or supervisee, psychologists must be aware that, in certain circumstances, they may be subject to vicarious liability - i.e., they may be legally responsible for the actions of the employee or supervisee. For vicarious liability to occur, (a) the psychologist must have the authority to control the employee or supervisee, (b) the employee's or supervisee's conduct must have deviated from the standard of care and must be the cause of the damage to the recipient of the services, and (c) the employee's or supervisee's conduct must have been within the scope of his or her designated responsibilities (Meyer, Simon, & Shuman, 2010).

Disclosing Confidential Information (part of Standard 4)

2. Disclosing Confidential Information: Standard 4.05 permits disclosure of confidential client information with (a) appropriate authorization to release information from the client or the client's legal representative or (b) without authorization "only as mandated by law, or where permitted by law for a valid purpose." For example, a psychologist is legally required to breach confidentiality to report child abuse to the appropriate authorities and is legally permitted to do so by contacting a collection agency when a client has failed to pay for the psychologist's professional services (Fisher, 2017).

Ethical Violations by Colleagues (part of Standard 1)

2. Ethical Violations by Colleagues: Responding to ethical violations by colleagues is addressed in Standards 1.04 and 1.05: Standard 1.04 requires psychologists to attempt to resolve another psychologist's ethical violation informally by bringing the violation to the psychologist's attention when it seems appropriate to do so. Standard 1.05 requires psychologists to report an ethical violation to an ethics committee, licensing board, or other appropriate authority or to take other "action appropriate to the situation" when the ethical violation has caused or is likely to cause substantial harm, is not appropriate for informal resolution, or was not adequately resolved informally. It's important to note that Standards 1.04 and 1.05 apply only when intervening does not violate any confidentiality rights. For example, if a current client tells you she was sexually harassed by her previous therapist but doesn't want you to tell anyone, you would maintain confidentiality and not take any action against the therapist. Koocher and Keith-Spiegel (2008) have identified several situations that may not be amenable to informal resolution. For example, informal resolution may not be appropriate or possible when the psychologist's violation involves addiction to alcohol or drugs or is related to a serious emotional disturbance or mental illness, when the violation is due to the psychologist's general incompetence, or when pre-existing bad feelings between the psychologists would make an informal approach too confrontational.

Sexual Harassment (part of standard 3)

2. Sexual Harassment: Standard 3.02 defines sexual harassment as "sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature" and that (a) "is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this" or (b) "is sufficiently severe or intense to be abusive to a reasonable person in the context." It also states that sexual harassment can involve a single severe behavior or multiple persistent behaviors. The identification of sexual harassment can be difficult, especially in ambiguous situations. For example, sexual harassment has clearly occurred in a quid pro quo ("something for something") situation in which an employer demands sexual favors from an employee in exchange for a promotion, salary increase, or other job benefit. But it's more difficult to determine if a person's behavior constitutes sexual harassment when the person occasionally tells off-color jokes or makes suggestive comments. However, as noted in Standard 3.02, an ambiguous behavior becomes sexual harassment when the perpetrator continues to engage in the behavior after being told it's unwelcome or offensive.

Harm (part of standard 3)

3. Harm: Standard 3.04 requires psychologists to "take reasonable steps to avoid harming" clients, supervisees, students, and others with whom they work and to minimize the effects of any harm that's foreseeable or unavoidable. As noted by Fisher (2017), this requirement does not apply to legitimate activities that may cause harm such as assigning a low grade to a failing student or assigning an accurate diagnosis to a client that disqualifies him from receiving disability insurance.

Personal Problems (part of Standard 2)

3. Personal Problems: Standard 2.06 requires psychologists to (a) refrain from beginning a professional activity when it's likely that a personal problem will impede the psychologist's effectiveness and (b) "take appropriate measures" when they become aware that a personal problem might negatively affect an ongoing professional activity. It also states that an appropriate measure might be to seek consultation to determine whether an ongoing professional activity should be limited, suspended, or terminated.

Multiple Relationships (part of standard 3)

4. Multiple Relationships: As defined in Standard 3.05(a), a multiple relationship occurs when a psychologist has a professional relationship with a person and (a) at the same time, has another professional relationship with that person or with someone closely associated with that person or (b) promises to enter into a relationship in the future with that person or a person closely associated with that person. This Standard does not prohibit all multiple relationships but, instead, only those that "could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness ... or otherwise risks exploitation or harm to the person with whom the professional relationship exists." Note that the Ethics Code does not explicitly prohibit nonsexual posttermination relationships. However, as noted by Fisher (2017), such relationships would be unethical "if the posttermination relationship was promised during the course of the original relationship or if the individual was exploited or harmed by the intent to have the posttermination relationship" (p. 131). Multiple relationships are also addressed in several APA guidelines. For example, Paragraph II.7 of the Guidelines for Child Custody Evaluations in Family Law Proceedings (APA, 2010) states that psychologists should "strive to avoid conflicts of interest and multiple relationships in conducting evaluations." It also identifies conducting custody evaluations with current or former psychotherapy clients and vice versa as multiple relationships. Similarly, Paragraph 4.02.01 of the Specialty Guidelines for Forensic Psychology (APA, 2013) states that "forensic and therapeutic psychological services to the same individual or closely related individuals ... [is a multiple relationship] that may impair objectivity and/or cause exploitation or harm." It also states that, when requested to provide concurrent or sequential forensic and therapeutic services, psychologists should refer the individual to another provider; but, when that's not possible, "to minimize the potential negative effects of this circumstance." Gottlieb's (1993) decision-making model proposes that psychologists consider three factors when considering whether or not to become involved in another professional relationship with a current client: (a) the power differential between the psychologist and the client, (b) the expected duration of each relationship, and (c) the clarity of termination of each relationship. The greater the power differential, the longer the duration of the two relationships, and the more likely that one or both relationships will resume in the future, the less acceptable it would be to become involved in the multiple relationship. Finally, Standard 3.05(b) states that, in situations in which a potentially harmful multiple relationship has occurred, psychologists must "take reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code." Reasonable steps include discussing the situation with the involved individual(s) and consulting with a colleague to determine the best course of action.

Unfair Discrimination (part of Standard 1)

4. Unfair Discrimination: Standard 1.08 states that psychologists must not discriminate against others when making decisions about their employment, advancement, tenure, or admissions to academic programs solely because they've filed or are the subjects of an ethics complaint. However, it also states that this prohibition "does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information."

Conflict of Interest (part of standard 3)

5. Conflict of Interest: Standard 3.06 requires psychologists to refrain from accepting a professional role that could be expected to "impair their objectivity, competence, or effectiveness or ... expose a person or organization ... to harm or exploitation." A psychologist may be violating this prohibition if he or she recommends that current clients buy a product or participate in an ancillary service when the psychologist has a financial interest in that product or service.

Third Party Requests for Services (part of Standard 3)

6. Third-Party Requests for Services: Standard 3.07 states that, "when psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved, ... [including] the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained, and fact that there may be limits to confidentiality." Guidelines for identifying whether the third party or the individual or organization receiving services is the client are provided in ASPPB's (2015) Supervision Guidelines for Education and Training Leading to Licensure as a Health Service Provider and APA's (2013) Guidelines for Forensic Psychology. The Supervision Guidelines states that "client" ordinarily refers "to a direct recipient of psychological health care services within the context of a professional relationship including a child, adolescent, adult, couple, family, group, organization, community, or other populations, or other entities receiving psychological services" (p. 2). However, it also states that, "in some circumstances (e.g., an evaluation that is court-ordered, requested by an attorney, an agency, or other administrative body), the client may be the individual or entity requesting the psychological services" (p. 3). In addition, the Guidelines for Forensic Psychology states that, in the context of forensic practice, "client" refers to "the attorney, law firm, court, agency, entity, party, or other person who has retained, and who has a contractual relationship with, the forensic practitioner" (p. 19).

Informed Consent (part of Standard 3)

7. Informed Consent: Standard 3.10(a) requires psychologists to obtain an informed consent using reasonably understandable language from recipients of their professional services unless providing those services "without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code." Exceptions to obtaining informed consent include conducting court-ordered evaluations and research that requires the use of deception.

Standard 10: Therapy

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Standard 8: Research and Publication

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Fact vs. Expert Witness (legal term)

A fact witness is a person "who testifies as to what he/she has seen, heard, or otherwise observed regarding a circumstance, event, or occurrence as it actually took place.... Fact witnesses are generally not allowed to offer opinion, address issues that they do not have personal knowledge of, or respond to hypothetical situations" (APA, 2013, p. 30). Fact witnesses may provide confidential client information in legal proceedings only with the authorization of the client or a court order. In contrast, an expert witness is a person "who by reason of education or specialized experience possesses superior knowledge respecting a subject about which persons having no particular training are incapable of forming an accurate opinion or deducing correct conclusions" (APA, 2013, p. 30). Psychologists who have been qualified as expert witnesses by the court are allowed to offer opinions and testimony about hypothetical situations.

Responding to a Subpoena

APA's Committee on Legal Issues (2006) has provided the following guidelines for responding to a subpoena: (1) Determine if the subpoena is legally valid. One reason it might be invalid is because it was improperly served. (2) If the subpoena is valid, a formal response is required, but you should first contact the client to discuss the possible implications of providing the requested information. (3) If the client authorizes you to release the information, you may do so. But, if the client doesn't authorize you to provide the requested information, contact the party who issued the subpoena to see if he/she is willing to withdraw or limit the request. (4) If the attempt to negotiate with the requester is unsuccessful, seek guidance from the court informally by letter or formally with a motion to quash the subpoena or a protective order. (5) If requested to provide information about the client in court or at a deposition and you do not have the client's authorization to do so, assert the psychotherapist-patient privilege on the client's behalf and reveal the information only with the client's authorization or a court order.

Accreditation

Accreditation is "the process of formal evaluation of an educational program, institution, or system against defined standards by an external body for the purposes of quality assurance and enhancement" (Frank, Taber, van Zanten, Scheele, & Blouin, 2020, p. 305). The APA Commission on Accreditation (APA-CoA) is the primary specialized accreditation agency in the United States for education and training in psychology. It accredits (a) doctoral programs in clinical psychology, counseling psychology, school psychology, and other developed practice areas; (b) doctoral internships in the aforementioned areas; and (c) postdoctoral residencies in the aforementioned areas and in specialty practice areas in health service psychology (e.g., clinical neuropsychology, forensic psychology). As described on the APA accreditation website, the primary purpose of APA accreditation is to assure "the public that a program has clearly defined training aims that meet professional and scientific standards that support the successful, ethical and skillful delivery of psychological service" (APA, n.d., para. 1). Its purpose is further elaborated in the Standards for Accreditation for Health Service Psychology and Accreditation Operating Procedures, which states that "accreditation is intended to protect the interests of students, benefit the public, and improve the quality of teaching, learning, research, and practice in health service psychology." (APA, 2018, p. 3).

Standard 5: Advertising and Other Public Statements

Addresses public statements, client testimonials, and in-person solicitation of business.

Standard 9: Assessment

Assessment Techniques and Results: Standard 9 provides ethical requirements for the use of assessment techniques and the interpretation and explanation of their results.

Assessment via telehealth (part of standard 9)

Finally, administering tests designed to be administered in-person via telepsychology is addressed in Guideline 6 of the Guidelines for the Practice of Telepsychology (APA, 2013). It states that "psychologists are encouraged to consider the unique issues that may arise with test instruments and assessment approaches designed for in-person implementation when providing telepsychology services." For example, Wright and colleagues (2020) recommend using wider confidence intervals when interpreting test scores in this situation because the margin of error is increased whenever scores are derived from nonstandardized administration procedures. They also stress the importance of noting in test feedback and reports how assessment procedures were altered and how the alterations might affect the interpretation of test scores.

Competency to Stand Trial (legal term)

Competency is also a legal term and refers to a defendant's current mental status. In criminal legal proceedings, competency to stand trial evaluations are the most common type of competency evaluations and involve assessing the ability of defendants to "cooperate with their attorneys and ... understand the charges and proceedings against them" (Gardner & Anderson, 2015, p. 128). Methods used to evaluate competency to stand trial include a clinical interview, a mental status exam, psychological tests (e.g., MMPI-2, WAIS-IV), review of collateral information, and competency specific tests. Other criminal competencies include competency to refuse the insanity defense, competency to plead guilty, and competency to waive the right to counsel. Note that competency is also addressed in civil proceedings. Evaluations of civil competencies "generally focus on an individual's ability to understand any of the information that is relevant to making an everyday decision" (Huss, 2009, p. 197) and include assessing competency to make a will, enter into a contract, and make medical decisions.

confidentiality vs. privilege (part of standard 4)

Confidentiality and privilege are sometimes confused. However, maintaining client confidentiality is an ethical obligation and, in some circumstances, a legal requirement, while privilege (privileged communication) is a legal term that refers to a client's right to confidentiality in legal proceedings. All 50 states have established laws that create some form of the psychotherapist-client privilege. The client or the client's legal representative is the holder of the privilege, which means that the client or his/her legal representative decides whether to claim (assert) or waive the privilege. However, psychologists may claim the privilege on behalf of a client when asked to disclose confidential client information in a legal proceeding. In addition, there are legally defined exceptions to privilege, and the court determines whether an exception applies in a particular circumstance. Legal exceptions to privilege vary, but common exceptions include cases in which the court has ordered an examination of a person to determine his/her competence to stand trial, a person is suing his/her therapist for malpractice, and a person is using his/her mental status as a claim or defense in a legal case.

Developmental Supervision Models of Supervision

Developmental models are based on the assumption that "supervisees progress through stages as they develop their clinical skills and that supervisees require different supervisory responses as the supervisees move through these stages" (Westefeld, 2009, p. 4). An example is the integrated developmental model (IDM; Stoltenberg, McNeill, & Delworth, 1998), which distinguishes between three levels of supervisee development that are characterized by different degrees of self-other awareness, motivation, and autonomy: - Level 1 supervisees are focused on themselves but engage in limited self-evaluation, are high in motivation and anxious about evaluation, and are very dependent on the supervisor. For these supervisees, the focus of supervision is on developing a relationship, providing structure and support, and helping the supervisee acquire skills. -Level 2 supervisees are better able to focus on their clients and exhibit empathy, have fluctuating levels of motivation and confidence, and vacillate between autonomy and dependence. For these supervisees, the supervisor should provide less structure, share responsibility with the supervisee, and provide support and constructive feedback. -Level 3 supervisees are able to stay focused on a client while attending to their own reactions to the client, are consistent in terms of motivation, and are confident about their own skills and judgment. For supervisees at this level, supervisors should adopt a collegial role and foster the supervisee's independence.

Discussing the Limits of Confidentiality (part of standard 4)

Discussing the Limits of Confidentiality: Standard 4.02(a) requires psychologists to discuss with recipients of psychological services "the relevant limits of confidentiality and ... foreseeable uses of the information generated through their psychological activities." And Standard 4.02(b) states that, "unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant."

Standard 7: Education and Training

Education and Training Programs: Standard 7.02 requires psychologists to take "reasonable steps" to ensure that descriptions of their education and training programs are accurate. For example, a continuing education course on hypnotherapy should not be described as "interactive" or "experiential" if it consists only of a two-hour lecture. Similarly, Standard 7.03 requires psychologists to ensure that course syllabi provide accurate information "regarding the subject matter to be covered, bases for evaluating progress, and the nature of course experiences." It notes, however, that psychologists may change course requirements when they believe doing so will be beneficial for students; but, in this situation, they must make students aware of the change "in a manner that enables them to fulfill course requirements." Standards 7.04 and 7.05 address course and program requirements. Standard 7.04 states that psychologists must not require students to disclose personal information in course- or program-related activities unless "(1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others." Standard 7.05 states that, when individual or group therapy is a requirement for an undergraduate or graduate course or program, students must be given the option of choosing a therapist who is unaffiliated with the course or program. In addition, "faculty who are or are likely to be responsible for evaluating students' academic performance ... [must not] themselves provide that therapy." Fisher (2017) provides the following guidelines for programs that require personal psychotherapy: (a) The requirement for mandatory personal psychotherapy is justified by the program's training objectives. (b) The requirement, its potential risks and benefits, and planned safeguards are described in program application materials. (c) Students are given some choice in their selection of therapists. (d) There will be no multiple relationships between students and therapists. (e) Students are given financially feasible choices for therapy so that it is affordable.

Malpractice Claims

For a client to succeed in a claim of malpractice against a psychologist, four conditions must be met (Gable, 1983): (a) The psychologist must have had a professional relationship with the client that established the psychologist's duty to conform to a professional standard of care. (b) There was a dereliction or breach of the duty on the part of the psychologist. (c) The client suffered injury or harm as a result of this dereliction or breach. (d) The psychologist's dereliction or breach of duty was the direct or proximate cause of the person's harm or injury. In addition, for the client to obtain monetary compensation, the harm or injury must be measurable in economic terms.

10 Ethical Standards (Names Only)

HER CAR TRAP Human Relations Education and Training Research and Publication Competence Advertising and Other Public Statements Resolving Ethical Issues Therapy Record Keeping and Fees Assessment Privacy and Confidentiality

Standard 3: Human Relations

Human Relations: Standard 3 (Human Relations) provides ethical requirements related to discrimination, harassment, multiple relationships, informed consent, and interruption of services.

3 Types of Accredidation

In the United States, there are three types of accreditation: national, regional, and specialized. National and regional accreditation are both institutional types of accreditation, which means they apply to an entire institution and all of its programs. Specialized accreditation is also known as program accreditation and applies to (a) a particular department, school, or program (e.g., a department of psychology, a school of behavioral sciences, or a program in clinical psychology) and (b) an entire freestanding specialized institution (e.g., a professional school of psychology). Accreditation procedures vary somewhat for different accreditation agencies but are guided by federal requirements. In general, these procedures include a self-study, a peer review and site visit by an outside team, and preparation of a comprehensive report by the team. Based on the self-study and peer review and report, the accrediting agency decides to award, renew, deny, or revoke accreditation or accredit on contingency or probation.

informed consent for telepsychology (part of standard 3)

Informed consent for telepsychology services is addressed in Guideline 3 of the APA's Guidelines for the Practice of Telepsychology. It states that "psychologists strive to obtain and document informed consent that specifically addresses the unique concerns related to the telepsychology services they provide" (2013, p. 795). Legal and organizational requirements for issues to address when obtaining a client's informed consent for telepsychology services vary, but the American Telemedicine Association's (2013) practice guidelines for videoconferencing recommend providing the following information: the limits to confidentiality, an emergency plan and contact information, the procedure for contact between sessions, the process for documenting and storing confidential information, the potential for technical failure, the procedure for coordinating care with other professionals, and the conditions under which telepsychology services may be terminated and a referral made for in-person treatment.

Insanity (legal term)

Insanity is a legal term, and its definition varies from jurisdiction to jurisdiction. In general, however, a defendant is considered "not guilty by reason of insanity" if, because of a mental disease or defect, he/she failed "to appreciate or understand that certain actions ... [were] wrong in a legal or moral sense" at the time of the crime (Nairne, 2014, p. 448). In some jurisdictions, "not guilty by reason of insanity" is replaced by "guilty but insane," "guilty but mentally ill," or other alternative. In the United States, the insanity defense is used in only 1% of all criminal cases and is successful about 25% of the time (Bartol & Bartol, 2019).

Maintaining, Disseminating, and Disposing of Records (part of standard 6)

Maintaining, disseminating, and disposing of records are addressed in Standards 6.01 and 6.02. Standard 6.01 identifies reasons why psychologists must create, maintain, and dispose of records in appropriate ways - e.g., to facilitate the transfer of services, to ensure the accuracy of billing, and to comply with legal and institutional requirements. Regarding forensic records, Kalmbach and Lyons (2006) note that "maintaining accurate records is important in all professional practice ... [but] forensic practice is held to a higher standard than general practice" (p.280): Forensic records are usually more detailed than clinical records are and should include all notes and materials that were used to form an opinion. In addition, forensic psychologists should keep in mind that "with the exception of relevant client/patient privilege, the entirety of the psychologist's records created or used in a case is subject to discovery" (Fisher, 2017, p. 234). Standard 6.02 provides guidelines for maintaining the confidentiality of records. Standard 6.02(b) states that psychologists "use coding or other techniques to avoid the inclusion of personal identifiers" when entering confidential information in databases or other record systems that permit access to unauthorized individuals. Techniques for protecting client confidentiality and privacy when using digital technologies include encrypting all client records and communications, using HIPAA-compliant cloud providers, using two-factor authentication, working with air-gapped computers (computers that are separated from networked data and internet access), and including information on risks associated with digital data storage and communication in informed consent discussions and documents (Lustgarten, 2016). Standard 6.02(c) requires psychologists to have plans for transferring client records and maintaining their confidentiality in the event of planned or unplanned withdrawal from practice. Methods for doing so include having a professional will, having an arrangement with a responsible colleague or professional association to manage the records, and instructing a spouse or executor on how to seek advice for the management of records (Koocher & Keith-Spiegel, 2016). Information about the minimum duration of time for maintaining professional records is provided in Guideline 7 of APA's (2007) Record Keeping Guidelines. It recommends that, in the absence of a superseding legal or institutional requirement, psychologists "consider retaining full records until 7 years after the last date of service delivery for adults or until 3 years after a minor reaches the age of majority, whichever is later." It also states that psychologists may want to retain records for a longer period, depending on the situation and the pros and cons of doing so.

Confidentiality when The Client is a Danger to others (part of standard 4)

Most jurisdictions have passed legislation that's consistent with the Tarasoff decision, a California Supreme Court decision that established a psychologist's duty to protect a third party who is at risk for physical harm by a therapy client. In most jurisdictions, the duty to protect applies only when the client communicates a clear and imminent threat of physical harm to an identifiable victim or victims and the client has the ability to carry out his or her threat. The appropriate action in this situation depends on the provisions of relevant legislation, but often includes warning the intended victim, notifying the police, or taking other reasonable steps such as hospitalizing the client. Finally, note that the Health Insurance Portability and Accountability Act (HIPAA) allows covered entities to disclose protected health information (PHI) without the client's authorization when the information will be used for treatment, payment, or health care operations. However, disclosure of PHI without authorization may not be allowed in these situations by state law and, in that situation, state law takes precedence over HIPAA. Standards 4.04, 4.06, and 4.07 address disclosing confidential information in specific situations: Standard 4.04(a) requires psychologists to "include in written and oral reports and consultations only information germane to the purpose for which the communication was made." This requirement echoes the requirements of HIPAA to limit disclosure of personal health to the minimum necessary to accomplish the purpose of the disclosure and the requirements of Paragraph 10.01 of APA's (2013) Specialty Guidelines for Forensic Psychology, which states that "forensic examiners seek to assist the trier of fact to understand evidence or determine a fact in issue, and they provide information that is most relevant to the psycholegal issue." In other words, a forensic evaluation and the report based on its results should focus on information that's relevant to the psycholegal questions addressed by the evaluation. Standard 4.06 allows psychologists to consult with colleagues about clients but requires them not to disclose identifying information about a client to a consultant without the client's authorization and to disclose only information that's "necessary to achieve the purposes of the consultation." Standard 4.07 states that psychologists must not use confidential client information in "writings, lectures, and other public media" unless they take reasonable steps to disguise the identity of the client, they have obtained written authorization from the client to do so, or there's legal authorization to do so. Fisher (2017) notes that simply substituting a pseudonym for the client's name is not likely to be sufficient, and she recommends that psychologists consider changing names, birthdates, and locations that are smaller than a state (which is required by HIPAA policy for de-identifying private health information) as well as "changing the season or year of an event or modifying details of family composition and other social networks that are not essential to the didactic goal" (p. 199).

Principle A

Principle A (Beneficence and Nonmaleficence) states that "psychologists strive to benefit those with whom they work and take care to do no harm."

Principle B

Principle B (Fidelity and Responsibility) calls for psychologists to "establish relationships of trust with those with whom they work ... [and to be] aware of their professional and scientific responsibilities to society and to the specific communities in which they work." It also states that "psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage."

Principle C

Principle C (Integrity) addresses the importance of promoting "accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology."

Principle D

Principle D (Justice) calls for psychologists to "recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists."

Principle E

Principle E (Respect for People's Rights and Dignity) states that psychologists "respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination" and "are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status."

Standard 4: Privacy and Confidentiality

Privacy and Confidentiality: Standard 4 (Privacy and Confidentiality) covers discussing the limits of confidentiality and disclosing confidential information.

Process-Based Models of Supervision

Process-based models are also known as social role models and "were developed to provide descriptions of the component roles, tasks, and processes within supervision and as a means to uniformly classify events occurring in supervision" (Falender & Shafranske, 2004, p. 17). An example is Bernard's (1979, 1997) discrimination model, which distinguishes between three focus areas for supervision and three supervisor roles. The focus areas are intervention (process) skills, conceptualization skills, and personalization skills, and the supervisor roles are educator, counselor, and consultant. At any given point in time, the supervisor can adopt one of nine approaches that represent different combinations of the focus areas and roles. For example, when a supervisee would like to use exposure therapy to treat a client's specific phobia but doesn't have the skills to do so, this is an intervention skills problem and the supervisor would adopt the role of educator and teach the supervisee the techniques of this therapy. In contrast, when a supervisee is unaware that his client is sexually attracted to him, this is a personalization problem and the supervisor would adopt the role of counselor and help the supervisee confront his own sexuality and determine what is causing his failure to recognize the client's sexual cues.

Professional/Ethical Guidelines for Supervision **need to break down into smaller chunks**

Professional guidelines for clinical supervision are provided by the ASPPB, APA, and CPA. The ASPPB's (2015) Supervision Guidelines for Education and Training Leading to Licensure as a Health Service Provider is "intended to assist jurisdictions in developing thoughtful, relevant and consistent supervision requirements" (p.2) and is "built upon the concept of competency-based supervision, an approach to supervision that enhances accountability and is applicable to all supervision models" (Falender & Lee, 2015, para. 4). This document identifies "the protection of and accountability to the public ... [as the] paramount goals of supervision" (p. 1) and indicates that this refers to the protection of the welfare of the supervisee's clients. It also lists the following as additional goals: protecting the supervisee, acting as a gatekeeper by assessing the supervisee's readiness for autonomous practice, facilitating the supervisee's professional development, remediating areas where the supervisee is not meeting the criteria for competence or ethical standards, and preparing the supervisee for independent practice. It also notes that "supervision is a discrete competency that presents unique ethical issues and challenges to supervisors and supervisees" (p. 6) and provides a description of several ethical issues that are especially relevant to clinical supervision: (a) Competence: "Among the ethical competencies essential for the supervisor are the values and skills involved in appropriately delegating a client to the supervisee and in the ongoing monitoring of the supervisee's clients, as well as the monitoring of the professional development of the supervisee" (p. 45). For example, with regard to a supervisee's professional development, supervisors must actively monitor the supervisee's interventions and the client's progress and provide the supervisee with constructive criticism. (b) Confidentiality: Supervisors should inform supervisees of the limits of confidentiality with regard to personal disclosures and evaluation and "ensure that the supervisee's clients have been informed of the supervisee's status as a trainee and that the supervisor is responsible for all services provided and has access to all clients' records" (p. 46). (c) Multiple Relationships: Supervisors must ordinarily avoid multiple relationships involving a supervisee "due to the potential loss of supervisor objectivity or exploitation of the supervisee" and be aware that, because of the power differential, "supervisees may not be able to refuse to engage in a multiple relationship or to withdraw once commenced" (p. 46). The ASPPB's Supervision Guidelines also addresses several other issues: It distinguishes between primary and delegated supervisors: A primary supervisor is a psychologist who's licensed at the doctoral level in the jurisdiction where he/she provides supervision and "has ultimate responsibility for the services provided by supervisees and the quality of the supervised experiences" (p. 4). A delegated supervisor is a "licensed health practitioner to whom the primary supervisor may choose to delegate certain supervisory responsibilities" (p. 3). The Supervision Guidelines also states that supervisors "generate and maintain records regarding dates of scheduled supervision as well as an accurate summary of the supervision and the supervisee's competence" and that "these records must be maintained until the supervisee obtains a license or for at least 7 years after the supervision terminates, whichever is greater" (p. 11). In addition, this document addresses telepsychology supervision (telesupervision) and states that telepsychology supervision at the practicum, doctoral, and post-doctoral levels shall not account for more than 50% of a supervisee's supervision. It also notes that interjurisdictional telepsychology supervision is not permitted except in emergency situations, that supervisors must verify a supervisee's identity at the beginning of each contact, and that supervisors must "inform the supervisee of the risks and limitations to telepsychology supervision, including limits to confidentiality, security, and privacy" (p. 23). The APA's (2014) Guidelines for Clinical Supervision in Health Service Psychology was "developed as a resource to inform education and training regarding the implementation of competency-based supervision" (p. ii), which it defines as "a metatheoretical approach that explicitly identifies the knowledge, skills and attitudes that comprise clinical competencies, informs learning strategies and evaluation procedures, and meets criterion-referenced competence standards consistent with evidence-based practices (regulations), and the local/cultural clinical setting" (p. 6). The guidelines included in this document address seven domains: supervisor competence; diversity; supervisory relationship; professionalism; assessment/evaluation/feedback; problems of professional competence; and ethical, legal, and regulatory considerations. They also identify protecting the welfare of the client as a supervisor's primary legal and ethical obligation, which means that supervisors give priority to protecting the well-being of supervisees' clients when responding to competence problems of supervisees. They also describe supervisors as "gatekeepers to the profession" and state that "gatekeeping entails assessing supervisees' suitability to enter and remain in the field" (p. 20). The CPA's (2009) Ethical Guidelines for Supervision in Psychology: Teaching, Research, Practice, and Administration provides "an ethical framework for maintaining an effective and mutually respectful working alliance between supervisor and supervisee ... [that] enhances learning, which ... results in the supervisee working to a higher standard of performance that protects from harm those who are affected by their work" (p. 2). It addresses four principles: respect for the dignity of persons, responsible caring, integrity in relationships, and responsibility to society.

Inducements for Research Participation (part of standard 8)

Providing inducements for participation in a research study is addressed in Standards 8.04 and 8.06. Standard 8.04 applies to situations in which participation is a course requirement or opportunity for extra credit and states that, in this situation, students must be "given the choice of equitable alternative activities." Standard 8.06 requires psychologists to "make reasonable efforts to avoid offering excessive or inappropriate financial or other inducements for research participation when such inducements are likely to coerce participation." It allows psychologists to offer professional services in exchange for research participation as long as prospective participants are informed about the nature of the services and potential risks, limitations, and obligations.

Public Statements (part of standard 5)

Public Statements: Standards 5.01, 5.02, and 5.04 cover public statements about psychologists' professional services made by themselves and others. Standard 5.01 states that "psychologists do not knowingly make public statements that are false, deceptive, or fraudulent concerning their research, practice, or other work activities or those of persons or organizations with which they are affiliated." This prohibition applies to a psychologist's training, experience, credentials, services, fees, and so on and to a variety of statements including those made in advertisements, licensing applications, resumes, directory listings, and lectures. Standard 5.01 also states that psychologists can claim as credentials for their mental health services only degrees that "were earned from a regionally accredited educational institution or ... were the basis for psychology licensure." Fisher (2017) interprets this requirement to mean that psychologists can use only two types of degrees as evidence of their qualifications to provide mental health services: a doctoral degree in psychology from an accredited educational institution or a degree from a nonaccredited educational institution for a program that has been approved by the state as qualifying psychologists for licensure. Standard 5.02 states that psychologists are responsible for public statements made by others they have retained to "promote their professional practice, products, or activities." It also states that psychologists "do not compensate employees of press, radio, television, or other communication media in return for publicity in a news item" and that psychologists must clearly identify paid advertisements for their services as such. Standard 5.04 addresses media presentations and states that, when psychologists provide "public advice or comment via print, Internet, or other electronic transmission ... [their statements must be] based on their professional knowledge, training, or experience." In addition, psychologists must not indicate that an interaction with an individual via the media establishes a professional relationship.

Assessment of Student and Supervisee Performance (part of standard 7)

Requirements for assessing the performance of students and supervisees are provided in Standard 7.06, which states that psychologists must "establish a timely and specific process for providing feedback to students and supervisees" and should give them information about this process at the beginning of the academic or supervisory relationship. It also requires evaluations to be based on the actual performance of students and supervisees with regard to "relevant and established program requirements." In other words, evaluations must not be based on personality characteristics or other factors that are not clearly linked to a student's or supervisee's actual performance. The dismissal of supervisees is not explicitly covered in the Ethics Code but is addressed elsewhere. For example, Corey, Haynes, Moulton, and Muratori note that "supervisees have due process rights ... and dismissal from a training program should be the last resort after other interventions have failed to produce any change in supervisees who exhibit deficiencies" (2010, p. 153). During the course of supervision, a supervisor must provide supervisees with regular constructive feedback and, when a supervisee exhibits problem behavior, the supervisor should provide the supervisee with appropriate remediation, which may include one or more of the following: increasing the amount of supervision, changing the format and/or focus of supervision, recommending personal therapy, reducing the supervisee's workload, requiring completion of academic coursework, or recommending a leave of absence or second internship in another setting. When these interventions do not satisfactorily rectify the problem, more formal action is taken and might involve placing the supervisee on probation, giving the supervisee a limited endorsement that indicates the settings in which he/she can function adequately, or terminating the supervisee from the training program. Of course, any of these actions must be adequately documented and done in ways that are consistent with the supervisee's right to due process procedures.

Standard 1: Resolving Ethical and Legal/Organizational Conflicts

Standard 1 (Resolving Ethical Issues) of the Ethics Code addresses conflicts between ethical and legal or organizational requirements, ethical violations by colleagues, responding to requests from ethics committees, and avoiding unfair discrimination against complainants and respondents in an ethics complaint.

Informed Consent for Therapy (part of standard 10)

Standard 10.01 requires psychologists to obtain informed consent from therapy clients "as early as is feasible in the therapeutic relationship"; and it states that, when doing so, clients should be informed about "the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality" and given an opportunity to ask and receive answers to their questions. This standard also states that, "when the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient ... [must be] informed that the therapist is in training and is being supervised and ... given the name of the supervisor."

Providing Therapy to Clients Served by Others (part of standard 10)

Standard 10.04 states that psychologists must "proceed with caution and sensitivity to the therapeutic issues" when asked to provide services to a person who is receiving services from another mental health professional. The appropriate action in this situation depends on the nature of the services being provided by the other professional. For example, if a client tells you during her first session that she's seeing another therapist for the same problem because she thinks doing so will help her resolve the problem more quickly, you would probably not want to continue seeing the client. In contrast, when a client is seeking therapy from you to deal with the recent death of his father and tells you he's also in group therapy for his long-standing gambling problem, it would be acceptable for you to accept him as a client. However, in this situation, you'd want to obtain the client's authorization to consult with the other therapist to coordinate the two treatments.

Sexual Intimacies (part of standard 10)

Standard 10.05 prohibits sexual intimacies with current clients under any circumstances, while Standard 10.08 prohibits sexual intimacies with former clients for at least two years following termination of therapy and then only in the "most unusual circumstances." Standard 10.08 also states that therapists "bear the burden of demonstrating" that a sexual relationship with a former client is not exploitative, which requires considering the following factors: (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient. Finally, Standard 10.06 prohibits psychologists from engaging in sexual intimacies with "individuals they know to be" relatives and significant others of current therapy clients, while Standard 10.07 prohibits psychologists from providing therapy to individuals they have been sexually involved with in the past.

Termination of Therapy (part of standard 10)

Standard 10.10 requires psychologists to terminate therapy when it becomes clear that a client no longer needs or is benefiting from it. However, as noted by Fisher (2017), this does not mean that a therapist and client cannot reevaluate the client's progress and determine if there's a valid reason to continue therapy (e.g., if there are additional treatment goals to address). This standard also states that it's acceptable to "terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship"; and, except in the latter situation, psychologists must provide clients with pretermination counseling and referrals to alternative service providers.

Standard 2: Competence

Standard 2 (Competence) of APA's Ethics Code addresses working within the boundaries of one's competence, delegating work to others, and dealing with personal problems.

2 types of behavior that constitute sexual harassment (standard 2)

Standard 3.02 of APA's Ethics Code distinguishes between two types of behavior that constitute sexual harassment: behaviors that create a hostile work environment and behaviors that are sufficiently severe or intense "to be abusive to a reasonable person."

Individuals incapable of giving informed consent (part of standard 3)

Standard 3.10 also provides ethical requirements for obtaining informed consent in specific situations: (a) Individuals Legally Incapable of Giving Consent: Standard 3.10(b) states that, when individuals are legally incapable of giving informed consent, psychologists should provide them with an appropriate explanation, consider their best interests, seek their assent, and obtain permission from a legally authorized person when doing so is permitted or required by law. This standard applies to adults who have been found to be legally incompetent and most youth under the age of 18. Laws that allow minors to consent to their own treatment vary from state to state but often include the following: emancipated minor, mature minor (minors who have sufficient maturity and intelligence to give informed consent), and minors with certain medical conditions such as alcohol or drug addiction or a sexually transmitted disease (Sirbaugh & Diekema, 2011). In addition, consent is presumed when a parent or legal guardian is required to give consent for a minor's treatment but is not available to do so and the circumstances are life-threatening for the minor (e.g., when the minor is at high risk for suicide). However, in this situation, consent should ordinarily be obtained for any resulting ongoing treatment (McNary, 2014). In the United States, providing emergency treatment to minors in an emergency department without the consent of a parent or legal guardian is permitted by the Emergency Medical Treatment and Labor Act (EMTALA) of 1986. It supersedes state law and is also known as the "doctrine of implied consent" because it assumes that, if the minor's parent or guardian were present, he or she would consent to the treatment (Benjamin, Ishimine, Joseph, & Mehta, 2017).

Interruption of Services (part of standard 3)

Standard 3.12 requires psychologists "to make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist's illness, death, unavailability, relocation, or retirement or by the client's/patient's relocation or financial limitations." When an interruption in services is foreseeable, a good strategy is to discuss the situation with the client and, as appropriate, provide pretermination counseling and/or referrals. To adequately plan for an interruption in services due to death, the best strategy is for a psychologist to have a professional will that designates a professional executor who will assume responsibility for contacting clients and ensuring the security of client records. The ASPPB's Guidelines for Closing a Psychology Practice states that the professional executor should be someone who understands relevant ethical obligations and legal requirements. It also notes that, ideally, "this individual should be a member of the profession or if this is not possible a member of another regulated health profession ... [but] should not be a member of the psychologist's own family due to the inherent conflict of interest that exists" (2020, p. 8).

Client Testimonials (part of standard 5)

Standard 5.05 prohibits psychologists from soliciting "testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence."

In-Person Solicitation of Business (part of standard 5)

Standard 5.06 prohibits psychologists from engaging "in uninvited in-person solicitation of business from actual or potential therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence." It excludes from this prohibition encouraging family members or others to participate in therapy to benefit a current therapy client and providing disaster relief or community outreach services.

Fees and Financial Arrangements (part of standard 6)

Standard 6.04 requires psychologists to reach an agreement with clients "as early as feasible" about fees and billing arrangements. This includes discussing fees for therapy sessions, billing and payment schedules, charges for missed appointments, issues related to third-party payors, and the policy for unpaid fees. With regard to the latter, Standard 6.04(e) states that psychologists may use collection agencies and other legal measures to collect unpaid fees but "must first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment." Of course, only limited information must be provided to a collection agency - i.e., the client's name, address, and phone number; the dates of the services; and the amount due for those services. Although sliding fee scales based on a client's income are not addressed in the Ethics Code, they are generally viewed as being acceptable as long as they're applied consistently and equitably and are consistent with state laws. Providing the first therapy session for free to new clients is also not addressed in the Ethics Code, and there's no clear consensus about the acceptability of doing so. There's some agreement, however, that it's acceptable when special precautions are taken, including making sure the person understands the limited purpose of the first session (e.g., to help the person decide if he/she wants to work with the therapist) and is made aware of the fee for future sessions before attending the first session (e.g., Miranda & Marx, 2003). Specific financial concerns and arrangements are addressed in Standards 6.03, 6.05, 6.06, and 6.07: Standard 6.03 prohibits psychologists from withholding client records when they're needed for a client's emergency treatment solely because the client has unpaid fees. Note that this prohibition applies to treatment and not to education, assessment, and other professional activities. Also note that withholding client records for nonpayment of fees in any situation may be illegal or inconsistent with institutional regulations. For example, the Health Insurance Portability and Accountability Act (HIPAA) does not allow providers to refuse to allow a patient to inspect or obtain a copy of his/her health record due to nonpayment of fees. Fees are also addressed in Paragraph 5.02 of the Guidelines for Forensic Psychology, which states that, "because of the threat of impartiality presented by the acceptance of contingent fees and associated legal prohibitions, forensic practitioners strive to avoid providing services on the basis of contingent fees" (p. 12). Standard 6.05 defines barter as "the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services." It also states that barter may be acceptable when it's not clinically contraindicated or exploitative. Many experts discourage bartering because of its potential for negative consequences, and some suggest that bartering goods for therapy is less risky than bartering services (e.g., Woody, 1998). Standard 6.06 requires psychologists to provide payors of their psychological services with accurate information about a client's diagnosis, the type of services provided, and the fees that were charged. To do otherwise would not only be unethical but would also constitute fraud. For example, it would be unethical and illegal to assign a client an inaccurate diagnosis in order to receive reimbursement from an insurance company, to indicate that services were provided by a psychologist when they were actually provided by the psychologist's supervisee, to bill an insurance company for individual therapy when group or family therapy was provided, to bill an insurance company for a client's missed appointments, or to routinely waive client co-payments without the insurance company's agreement with this practice. Standard 6.07 states that, when psychologists give or receive referral fees, the fee must be "based on the services provided ... [and not] on the referral itself." For example, it would be unethical for a psychologist to pay a colleague a referral fee for each client the colleague refers to him unless the fee represents the actual costs of the referral - e.g., the time the colleague spent discussing the client with the psychologist and copying and forwarding the client's file. Note that this prohibition does not apply to psychology referral services, dividing fees with another professional when the psychologist and other professional both provided services to a client, or paying employees a percentage of a client's fee (Fisher, 2017).

Sexual Relationships with Students and Supervisees (part of standard 7)

Standard 7.07 prohibits psychologists from becoming sexually involved with students or supervisees "who are in their department, agency, or training center or over whom ... [they] have or are likely to have evaluative authority."

Informed Consent for Research (part of standard 8)

Standard 8.02 states that prospective research participants should be given the following information during the informed consent process: (1) the purpose of the research, expected duration, and procedures; (2) their right to decline to participate and to withdraw from the research once participation has begun; (3) the foreseeable consequences of declining or withdrawing; (4) reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort, or adverse effects; (5) any prospective research benefits; (6) limits of confidentiality; (7) incentives for participation; and (8) whom to contact for questions about the research and research participants' rights. Standard 8.02 also states that, when research involves evaluating the effects of experimental treatments, prospective participants must be told about the experimental nature of the treatments, available alternative treatments, the way participants will be assigned to experimental and control groups, and, if appropriate, any treatments or services that will not be provided to participants assigned to the control group. Standard 8.02 does not address research with children and adolescents or others who are legally incapable of giving informed consent, but Standard 3.10(b)'s general requirement for obtaining assent from these individuals applies to their participation in research. In addition, Fisher (2017) points out that U.S. federal regulations (CFR 46.408) permit waiver of a child's assent to participate in research that involves a therapeutic intervention when (a) the child does not have the capacity to consent or (b) the research offers benefits to the health of the child that cannot be obtained from interventions available outside the research study. In other words, the consent of a child's legal guardians ordinarily overrides the dissent of the child when the research offers direct health benefits to the child. However, the child's dissent ordinarily overrides the consent of legal guardians when the research does not offer direct health benefits to the child (Institute of Medicine, 2004). Standard 8.05 states that psychologists may dispense with informed consent when doing so is permitted by law or federal or institutional regulations or when the research is not likely to cause distress or harm to subjects and involves (a) studying routine educational practices in educational settings; (b) studying factors related to job or organizational effectiveness in organizational settings when participants' confidentiality will be maintained and there's no risk to their employment; or (c) using anonymous questionnaires, naturalistic observations, or archival research when participants' confidentiality will be maintained and there's no risk for legal liability or other harm. In addition, Standard 8.03 states that it may be unnecessary to obtain informed consent prior to recording subjects' voices or images when the study (a) involves naturalistic observations in public places where there's no expectation of privacy and observations are not likely to cause personal identification or harm or (b) involves deception and consent to use the recording will be obtained during debriefing.

Use of Animals in Research (part of standard 8)

Standard 8.09 states that the care, use, and disposal of animal subjects must be done in a humane manner and in compliance with relevant laws, regulations, and professional standards. It also states that "psychologists trained in research methods and experienced in the care of laboratory animals supervise all procedures involving animals and are responsible for ensuring appropriate consideration of their comfort, health, and humane treatment" and for ensuring that people "under their supervision who are using animals have received instruction in research methods and in the care, maintenance, and handling of the species being used, to the extent appropriate to their role." In addition, Standard 8.09 requires psychologists to use procedures that cause animals to experience "pain, stress, or privation only when an alternative procedure is unavailable ... [and doing so is justified by the study's] prospective scientific, educational, or applied value." When an animal's life must be terminated, psychologists must do so rapidly and in a way that minimizes pain and is consistent with accepted procedures.

Duplicate Publication of Data (part of standard 8)

Standard 8.13 states that "psychologists do not publish, as original data, data that have been previously published" but notes that "this does not preclude republishing data when they are accompanied by proper acknowledgement." In her clarification of this requirement, Fisher states that psychologists are not prohibited "from publishing the same data in different journals ... as long as proper citations of the original publication source are provided and psychologists have confirmed that such publication does not violate the original publisher's copyright" (2017, p. 332). Note that concurrent (simultaneous) submission of the same article for publication to multiple journals is not addressed in the Ethics Code. However, as noted by Belcher (2019), it is unacceptable for the author(s) of a journal article to simultaneously submit the same journal article to more than one journal. Instead, the author(s) should submit the article to one journal at a time and wait for it to be rejected by one journal before submitting it to another journal. In addition, submission guidelines for APA journals include the following statement: "APA policy prohibits an author from submitting the same manuscript for concurrent consideration by two or more publications."

Sharing Research Data for Verification (part of standard 8)

Standard 8.14 states that, following publication of their research results, psychologists share data from that research with competent professionals who want to reanalyze the data to verify the study's findings as long as the confidentiality of participants is protected. This requirement implies that psychologists must retain their research data but does not specify the minimum duration of time for doing so. Requirements for retaining research data are provided elsewhere, but the requirements vary: The 6th edition of APA's (2010) Publication Manual states that authors of articles published in an APA journal must maintain raw data for at least five years after publication of the article, and current submission guidelines for APA journals state that "APA expects authors to have their data available throughout the editorial review process and for at least 5 years after the date of publication." However, the 7th edition of the Publication Manual (2020) does not specify a number of years. Instead, it states that "authors are expected to retain the data associated with a published article in accordance with institutional requirements; funder requirements; participant agreements; and, when publishing in an APA journal, the APA Ethics Code" (p. 13). For example, research that involves collecting identifiable health information is subject to HIPAA regulations, which state that records must be retained for at least 6 years after a participant has signed an authorization. [Note that the reference in the 7th edition of the Publication Manual to requirements in the APA Ethics Code is unclear because a minimum length of time for retaining research data is not specified in any of the Ethics Code's Standards.]

informed consent for assessment (part of standard 9)

Standard 9.03(a) states that, during the informed consent process, a person should be provided with information about "the nature and purpose of the assessment, fees, involvement of third parties, and limits of confidentiality" and given an opportunity to ask and receive answers to his/her questions. This standard notes that informed consent is ordinarily obtained but that there are exceptions - e.g., informed consent is unnecessary when the assessment is mandated by law or governmental regulations (e.g., when it is court-ordered) and when "informed consent is implied because testing is being conducted as a routine educational, institutional, or organizational activity." Standard 9.03(b) states that, when the person to be assessed has "questionable capacity to consent" or when the assessment is mandated, the person should be provided with information about the general nature and purpose of the assessment in "reasonably understandable" language. In her discussion of Standard 9.03(b), Fisher (2017) notes that describing the purpose of a test of malingering to an examinee might compromise the test's validity but that deceiving the examinee about the purpose might violate the examinee's autonomy rights. She states that, as a resolution of this dilemma, "current standards of practice support communicating to ... [examinees] that measures will be used to assess the examinee's honesty and efforts to do well, without describing the particularities of the tests that will be used to measure exaggeration or other elements of malingering" (p. 361). Finally, Standard 9.03(c) states that, when using the services of an interpreter to assist with the assessment of a client, psychologists obtain informed consent from the client for use of the interpreter, make sure that confidentiality of test results and test security are maintained, and include in their feedback and reports a description of any limitations of the obtained data resulting from use of an interpreter.

Test Data and Materials (part of standard 9)

Standard 9.04 describes "test data" as including "raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during an examination." It also states that, while psychologists ordinarily release test data to the client or the person identified in the client's authorization, they may refrain from doing so to protect the client or others from harm or misuse of the data as long as this is permitted by law. For example, the Health Insurance Portability and Accountability Act (HIPAA) allows covered entities to withhold test data when its release is reasonably likely to endanger the life or physical safety of the client or other person [45 CFR 164.524(a)(3)]. Standard 9.11 describes "test materials" as including "manuals, instruments, protocols, and test questions or stimuli." It also requires psychologists to "make reasonable efforts" to protect the integrity and security of test materials in ways that are consistent with legal requirements and contractual obligations. As noted by Fisher (2017), this requirement does not prohibit psychologists from discussing an individual test item with a client when doing so will help the client understand his/her test results.

Reporting and Publishing Research Results (part of standard 8)

Standards 8.10 and 8.11 prohibit psychologists from fabricating data, require psychologists to take "reasonable steps" to correct errors in their published data, and prohibit psychologists from plagiarizing - i.e., from presenting "portions of another's work or data as their own, even if the other work or data source is cited occasionally." Standard 8.12 requires psychologists to take credit "only for work they have actually performed or to which they have substantially contributed." It states that "principal authorship and other publication credit [must] accurately reflect the relative scientific or professional contributions of the individuals involved, regardless of their relative status" and that minor contributions (e.g., data collection or entry) "are acknowledged appropriately, such as in footnotes or in an introductory statement." Standard 8.12 also states that, except in "exceptional circumstances," students must be listed as the principal author on multiple-authored articles that are substantially based on their doctoral dissertations.

Confidentiality when The Client is a Danger to Him/Herself (part of standard 4)

When a psychologist believes a client is at high risk for suicide, the psychologist must take appropriate action to protect the client's safety. In some situations, this may require breaching client confidentiality - for example, when the psychologist determines that the best course of action is to have the client hospitalized. [Note that no-suicide contracts (also known as no-harm contracts or agreements) are sometimes employed in this situation, but there's no evidence that they're effective for preventing suicide or protecting psychologists from malpractice liability when a client commits suicide. Consequently, they should not be used as the sole intervention.]

Telepsychology - Interjurisdictional Practice

Telepsychology is also known as teletherapy and telehealth and is defined in the APA's Guidelines for the Practice of Telepsychology "as the provision of psychological services using telecommunication technologies ... [which include services provided via] telephone, mobile devices, interactive videoconferencing, e-mail, chat, text, and Internet" (2013, p. 792). Interjurisdictional practice refers to providing telepsychology services to clients who are located in another state, province, or country. In most jurisdictions, "legal and regulatory requirements are based on those in effect in the location of the client/patient at the time of contact rather than those in effect in the location of the practitioner" (Luxton, Nelson, & Maheu, 2016, p. 32). For jurisdictions that are not part of PSYPACT (see below), laws vary with regard to the interjurisdictional provision of telepsychology services. Some jurisdictions have laws that apply to interjurisdictional practice while others do not, and the existing laws vary. For example, some states require in-state licensure for telepsychology, which means that psychologists must be licensed in those states to provide telepsychology services to clients who are permanently or temporarily located in those states. In other states, psychologists licensed in another state may provide telepsychology services for a limited number of days to clients located in those states. In response to COVID-19, some jurisdictions have temporarily changed their laws to increase access to telepsychology. A link to a summary of these changes is available on the ASPPB website (https://www.asppb.net/page/covid19). Psychologists must consider several factors when providing telepsychology services to clients located in other jurisdictions regardless of the jurisdiction's status with regard to PSYPACT. For example, they should be familiar with laws related to child and elder abuse reporting, the duty to warn or protect, and civil commitment in the jurisdictions where their clients are located. They must also familiarize themselves with local resources that are available to clients in emergency situations. Moreover, practitioners of telepsychology should, to the extent feasible, advertise their telepsychology services only to individuals they are legally authorized to provide those services to. This includes indicating the geographical locations where they provide online services in their ads, brochures, and professional websites (American Association for Marriage and Family Therapy, 2017).

Journal Article Reporting Standards

The APA's development of Journal Article Reporting Standards (JARS) followed the release of several other standards. For example, the Consolidated Standards of Reporting Trials (CONSORT) was a model for JARS and was developed by medical experts as guidelines for reporting randomized control trials. JARS for quantitative, qualitative, and mixed methods research are available from several sources including two articles in the American Psychologist (Appelbaum, et al., 2018; Levitt, et al., 2018), the Publication Manual of the American Psychological Association (APA, 2020), and an APA website (https://apastyle.apa.org/jars). JARS for quantitative research include guidelines for experimental and nonexperimental research, replication studies, studies using structural equation modeling, and meta-analyses. The guidelines list the information that should be included in a manuscript's title page and abstract and in its introduction, methods, results, and discussion sections. For example, they indicate that the abstract for a meta-analysis should provide the following information: the study's objectives, eligibility criteria for a study's inclusion in the analysis, statistical and other methods used to synthesize the studies included in the analysis, the results of the meta-analysis (primary outcomes and effect sizes and confidence intervals), and conclusions.

PSYPACT

The ASPPB's Psychology Interjurisdictional Compact (PSYPACT) is an interjurisdictional agreement that allows psychologists who have a doctoral degree in psychology and an active, unrestricted license in a compact state to legally provide professional services to clients in other compact states via telepsychology or on a temporary in-person, face-to-face basis without being licensed in those states. (A list of current PSYPACT states is available at https://psypact.org/page/psypactmap.) 1. Telepsychology: For psychologists licensed in a compact state to provide telepsychology services to clients in other compact states, they must obtain an E.Passport from the ASPPB and an Authority to Practice Interjurisdictional Telepsychology (APIT) from the PSYPACT Commission. When these have been obtained, psychologists may practice telepsychology in any compact state without obtaining additional licenses. Note that, when providing telepsychology to a client in another compact state, psychologists must initiate contact with the client while they are physically located in their home states and that their scope of practice is limited to the scope of practice for psychologists licensed in the client's state. 2. Temporary Services: For psychologists licensed in a compact state to provide services on a temporary in-person, face-to-face basis to clients in other compact states, they must obtain an Interjurisdictional Practice Certificate (IPC) from the ASPPB and a Temporary Authorization to Practice (TAP) from the PSYPACT Commission. When these have been obtained, psychologists may provide in-person, face-to-face services to clients in any compact state for up to 30 days per calendar year without obtaining additional licenses. When providing temporary services to a client in another compact state, psychologists must limit their scope of practice to the scope of practice for psychologists in the client's state and adhere to applicable laws of that state.

Forensic Psychology: Psychological Autopsy (Legal Term)

The term "psychological autopsy" was coined by Shneidman (1994) who described its primary function to be clarifying deaths that were equivocal with regard to the manner of death. La Fon (1999) subsequently distinguished between two types of psychological autopsy: -Equivocal death psychological autopsy (EDPA) is closer to the procedure Shneidman described. It is used when the manner of a person's death is ambiguous and involves collecting the information needed to classify the manner of death as suicide, accident, homicide, natural cause, or undetermined. -Suicide psychological autopsy (SPA) is used to identify the psychosocial factors that contributed to a person's suicide. SPAs are conducted for forensic, research, and clinical purposes (Knoll, 2008): In forensic investigations, SPAs help resolve questions related to insurance claims, contested wills, malpractice claims, worker's compensation, and other legal issues. With regard to research, SPAs help identify suicide risk factors and methods of prevention. As a clinical tool, SPAs provide information that helps family members understand the deceased's state of mind at the time of death and facilitates their grieving process. Psychological autopsies are often conducted by psychologists, psychiatrists, and other mental health professionals who have had training in forensic psychology and/or death investigation. Information is obtained from multiple sources, including the crime scene, medical and police records, records left by the deceased person (e.g., suicide note, letters and emails, bank accounts, employee or student records), and interviews with family members, close friends, and co-workers. The primary criticisms of the psychological autopsy are a lack of standardized procedures, limited empirical evidence for its reliability and validity, and the potential that obtained information is incomplete, inconsistent, and/or biased. Consequently, a psychological autopsy is accepted as the basis of expert testimony in some civil cases but is unlikely to be accepted in criminal cases (Costanzo & Krauss, 2021). However, despite its limitations, the psychological autopsy continues to be considered an important tool for identifying risk factors associated with suicide (e.g., Pouliot & De Leo, 2006).

Deception in Research (part of Standard 8)

The use of deception in research precludes the ability to obtain a truly informed consent from prospective participants. Consequently, as stated in Standard 8.07, deception must be used only when certain conditions are met: It must be "justified by the study's significant prospective scientific, educational, or applied value" and alternative nondeceptive procedures must be unavailable. Also, participants must (a) not be deceived about procedures that are likely to cause "physical pain or severe emotional distress," (b) be allowed to withdraw their data from the study at any time, and (c) be informed about the deception "as early as is feasible, preferably at the conclusion of their participation, but no later than at the conclusion of the data collection."

Responding to Negative Online Reviews

Unfavorable online reviews on Yelp and other websites have become a source of stress for many psychologists. The appropriate response to these reviews is not addressed in ethical guidelines but has been addressed elsewhere. For example, Chamberlin (2014) notes that it's often not possible to get negative reviews deleted from a website unless they violate the website's terms of service, that responding directly to negative reviews on a website is likely to violate ethical responsibilities and HIPAA's privacy rule, and that counteracting negative reviews by soliciting and posting positive testimonials from current clients or others vulnerable to undue influence violates ethical requirements. Her recommendation is to reduce the effects of negative reviews by establishing a positive online presence - for example, by posting patient-satisfaction ratings or positive evaluations from colleagues and supervisors. She also notes that, when a psychologist receives several negative reviews, this might suggest that consultation would be useful to determine if the psychologist needs to make some changes in his/her practice.

Difference b/w Ethics Standards and Principles

Unlike the enforceable Ethical Standards, the General Principles, "should not form the basis for imposing sanctions."

Psychotherapy-Based Supervision Models of Supervision

When using one of these models, "theoretical orientation informs the observation and selection of clinical data for discussion in supervision as well as the meanings and relevance of those data" (Falender & Shafranske, 2004, p. 9). Included in this category are person-centered supervision and cognitive-behavioral supervision. Consistent with person-centered therapy, person-centered supervision focuses on the relationship between the supervisor and supervisee rather than the process of supervision and involves providing the conditions of empathy, genuineness, and unconditional positive regard. The structure of cognitive-behavioral supervision sessions parallels the structure of cognitive-behavioral therapy, with each session consisting of the following components: check-in, building a bridge to the last session, setting and working through an agenda, summarizing, assigning homework, and getting feedback. It also incorporates the techniques of cognitive-behavioral therapy including establishing a collaborative relationship and using behavioral rehearsal, Socratic questioning, and guided imagery (Beck et al., 2008).

Avoiding biased language re: age

a) Avoid using "males" and "females" as nouns except when a group includes individuals with a broad range of ages. Instead, for individuals 12 years of age and younger, use terms such as "child," "boy," and "girl." For individuals 13 to 17 years old, use terms such as "young person" and "adolescent." For those aged 18 years and older, use "adult," "woman," and "man." (b) For individuals aged 65 and older, appropriate terms include "older adult" and "persons 65 years of age and older." Avoid using such terms as "elderly," "senior citizens," and "the aged."

Discussing confidentiality with couples and families (part of standard 4)

a) Couples and Families: Standard 10.02 of the Ethics Code requires psychologists working with couples or families to clarify at the outset of therapy which individuals are the clients and "the probable uses of the services provided or the information obtained." This includes informing all individuals how information shared separately with the therapist by one partner or family member will be handled - i.e., will all information disclosed by an individual be kept confidential or will some or all of the information be shared with the other partner or other family members?

avoid biased language re: racial and ethnic groups

a) For people of African origin, use the terms "African American" or "Black." Alternatively, be more specific by indicating the region or nation of origin (e.g., Nigerian or Haitian). (b) For people of Asian ancestry from Asia, use the term "Asian"; for those from the United States or Canada, use "Asian American" or "Asian Canadian." Alternatively, be more specific by indicating the region or nation of origin (e.g., Japanese or Japanese American). (c) For people who identify as Hispanic, Latino or Latina, or other related designation, use the term preferred by the individual or population. Alternatively, use "Latinx" or other inclusive term or indicate the region or nation of origin (e.g., Salvadoran or Costa Rican). (d) For people of European origin, use terms such as "European," "European American," and "European Canadian"; for those living in North America, "White" is also acceptable. When possible, be specific about an individual's national or regional origin (e.g., Italian, Southern European). (e) For indigenous people, use the names they call themselves (e.g., Native American, Hawaiian Native, Pacific Islander, Alaska Native). Alternatively, the terms "Indigenous Peoples" or "First Nations" or the names of specific nations may be preferable (e.g., Cherokee, Navaho, Inuit). (f) For people of Middle East or North African origin, use the terms the individual prefers or, if a preference cannot be determined, use the term "Middle Eastern and North African" (MENA) or indicate the nation of origin. People of MENA descent who claim Arab ancestry and live in the U.S. may be referred to as "Arab Americans."

Assessment Conclusions (part of standard 9)

a) Standard 9.01 requires psychologists to ensure that the conclusions they derive from assessment results are based on sufficient information and, when appropriate, to communicate any limitations of their conclusions and decisions. For example, when your conclusions about an older adult's mental competence are based, to some degree, on the results of an evaluation conducted by another mental health professional, you'd want to explain why it was necessary to use those results and how doing so may have affected your conclusions.

assessment results, scoring, and feedback (part of standard 9)

c) Allowing unqualified individuals to use psychological assessment techniques is prohibited by Standard 9.07, except when doing so is for the purpose of training the individual and the individual is provided with appropriate supervision. (d) Standard 9.08(a) prohibits psychologists from basing decisions and recommendations on test results "that are outdated for the current purpose," and Standard 9.08(b) prohibits psychologists from basing decisions and recommendations on tests "that are obsolete and not useful for the current purpose." An implication of these requirements is that it may be acceptable to use outdated tests results and obsolete tests when they are appropriate for the purpose of a current evaluation. This issue is addressed by Bush and colleagues (2018) who state that the publication of a revised version of a test does not necessarily make the previous version obsolete or make its use unethical. They point out that "continued use of a prior version in some instances can be more consistent with the ethical responsibility to provide services that are beneficial" (p. 323). For example, it's likely to be more appropriate to use the newest version of a test when there are significant cohort changes in test scores over time (e.g., population changes in IQ scores). However, it's likely to be more appropriate to use the previous version of a test that has norms for an examinee's racial/ethnic group when the new version does not yet have norms for that group. Finally, note that the Ethics Code and Standards for Educational and Psychological Testing do not provide guidelines for determining when a test or test results become obsolete or indicate an acceptable length of time for adopting a revised version of a test. (e) The use of automated and other test scoring and interpretation services is addressed in Standard 9.09, which requires psychologists to choose these services on the basis of their validity and other relevant factors. This standard also states that psychologists "retain responsibility for the appropriate application, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use automated or other services." (f) Standard 9.10 states that psychologists must take "reasonable steps" to explain assessment results to the individual or his/her representative unless the situation precludes this requirement which may occur, for example, when the assessment is part of employment screening or forensic evaluation. However, in these situations, the reason for preclusion should be discussed with the person prior to assessment.